Ferrybridge Medical Centre NewApproachComprehensive Report … · 2019. 11. 23. · Thisreportdescribesourjudgementofthequalityofcareatthisservice.Itisbasedonacombinationofwhatwefound

This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.

Ratings

Overall rating for this service Outstanding –

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive to people’s needs? Outstanding –

Are services well-led? Outstanding –

FFerrerrybridgybridgee MedicMedicalal CentrCentreeQuality Report

8-10 High StreetKnottingleyWakefieldWF11 8NQTel: 01977 631623Website: www.ferrybridgemedicalcentre.com

Date of inspection visit: 8 September 2015Date of publication: 19/11/2015

1 Ferrybridge Medical Centre Quality Report 19/11/2015

Contents

PageSummary of this inspectionOverall summary 2

The five questions we ask and what we found 4

The six population groups and what we found 7

What people who use the service say 10

Detailed findings from this inspectionOur inspection team 11

Background to Ferrybridge Medical Centre 11

Why we carried out this inspection 11

How we carried out this inspection 11

Detailed findings 13

Overall summaryLetter from the Chief Inspector of GeneralPractice

We carried out an announced comprehensive inspectionat Ferrybridge Medical Centre on 8 September 2015.Overall the practice is rated as outstanding.

Please note that when referring to informationthroughout this report, for example any reference to theQuality and Outcomes Framework data, this relates to themost recent information available to the CQC at thattime.

Our key findings across all the areas we inspected were asfollows:

• Staff understood and fulfilled their responsibilities toraise concerns and report incidents and near misses.All opportunities for learning from internal andexternal incidents were maximised.

• The practice used innovative and proactive methodsto improve patient outcomes, working with other localproviders to share best practice. For example, thepractice had identified a gap in the sexual healthservice in the area and they had commenced a weeklyyouth clinic for patients under the age of 18 years.

• Patients said they were treated with compassion,dignity and respect and they were involved in theircare and decisions about their treatment. Informationwas provided in a number of formats to help patientsunderstand the care available to them.

• The practice worked closely with other organisationsand with the local community in planning howservices were provided to ensure that they meetpeople’s needs. The practice had pioneered GP andadvanced nurse practitioner (ANP) appointments atPontefract General Infirmary to improve access forpatients at weekends and to reduce the burden on thelocal accident and emergency department.

• The practice implemented suggestions forimprovements and made changes to the way itdelivered services as a consequence of feedback frompatients and from the Patient Participation Group(PPG).

• The practice had good facilities and was well equippedto treat patients and meet their needs.

• Information about how to complain was available andeasy to understand

• The practice had a clear vision which had quality andsafety as its top priority. A business plan was in place,

Summary of findings


was monitored and regularly reviewed and discussedwith all staff. High standards were promoted andowned by all practice staff with evidence of excellentteam working across all roles.

We saw several areas of outstanding practice including:

• The practice had shared the outcomes of a clinicalaudit undertaken within the practice relating toguidance published by the National Institute forHealth and Care Excellence (NICE). They had sharedthe outcomes internally, locally with the ClinicalCommissioning Group and nationally in a publishedpaper in the British Journal of General Practice inSeptember 2015.

• The practice had identified a gap in the sexual healthservice in the area. An advanced nurse practitioner(ANP) had been recruited to improve access to adviceand support, particularly for young people. The nursehad worked with the Terence Higgins Trust tocommence a weekly youth clinic for patients under theage of 18 years.

• The practice offered separate advice lines for childrenand those with long term conditions during openinghours. These were staffed by the ANPs. This enabledpatients to access clinical support and advice andwhere necessary and appropriate be prescribedmedicines. Patients said they found this to be a veryuseful service.

• The practice worked with the local ClinicalCommissioning Group (CCG) to improve access toservices at weekends. They had pioneered GP andadvanced nurse practitioner appointments atPontefract General Infirmary (A common venue wherepatients go to the accident and emergencydepartment). They had written the business case,managed the pilot and assumed informationgovernance responsibility. GPs and ANPs from thepractice had filled the rota for these clinics. Thisscheme had been launched in February 2015 and hadbeen extended until end of September 2015.

However there were areas of practice where the providershould make improvements:

• Improvements should be made in the dispensary atthe branch surgery in relation to security and receipt ofwaste medicines. Dispensary staff should be involvedin root cause analysis where there are significantevents or near misses in their area.

• The High Street building should have more immediateaccess to a defibrillator.

Professor Steve Field (CBE FRCP FFPH FRCGP)Chief Inspector of General Practice

Summary of findings


The five questions we ask and what we foundWe always ask the following five questions of services.

Are services safe?The practice is rated as good for providing safe services. Staffunderstood and fulfilled their responsibilities to raise concerns, andto report incidents and near misses. Lessons were learned andcommunicated widely to support improvement. Information aboutsafety was recorded, monitored, appropriately reviewed andaddressed. Risks to patients were assessed and well managed.There were robust systems in place to safeguard children and adultswhose circumstances may make them vulnerable.

Improvements should be made in the dispensary at the branchsurgery in relation to security and receipt of waste medicines.Dispensary staff should be involved in root cause analysis wherethere are significant events or near misses in their area. The HighStreet building should have more immediate access to adefibrillator.

Good –––

Are services effective?The practice is rated as good for providing effective services. Ourfindings at inspection showed that systems were in place to ensurethat all clinicians were up to date with both National Institute forHealth and Care Excellence (NICE) guidelines and other locallyagreed guidelines. We saw evidence to confirm that these guidelineswere positively influencing and improving practice and outcomesfor patients. They had shared findings from clinical audits regionallyvia the CCG and nationally through publication in a professionaljournal. Data showed patient outcomes were at or above average forthe locality. The practice used innovative and proactive methods toimprove patient outcomes and it linked with other surgeries andorganisations to share best practice. The practice had identified agap in the sexual health service in the area and a nurse had workedwith the Terence Higgins Trust to commence a weekly youth clinicfor patients under the age of 18 years.

Staff had received training appropriate to their roles and any furthertraining needs had been identified and appropriate training plannedto meet these needs. There was evidence of appraisals and personaldevelopment plans for all staff. Staff worked well withmultidisciplinary teams.

Good –––

Are services caring?The practice is rated as good for providing caring services. Datashowed that patients rated the practice higher than others forseveral aspects of care. Patients said they were treated withcompassion, dignity and respect and they were involved in decisions

Good –––

Summary of findings


about their care and treatment. Information for patients about theservices available was easy to understand and accessible. Staff weremotivated and inspired to offer kind and compassionate care andworked to overcome obstacles to achieving this. We found positiveexamples to demonstrate how patient’s choices and preferenceswere valued and acted on. We also saw that staff treated patientswith kindness and respect, and maintained confidentiality.

Are services responsive to people’s needs?The practice is rated as outstanding for providing responsiveservices. The practice reviewed the needs of its local population andengaged with the NHS England Area Team and ClinicalCommissioning Group (CCG) to secure service improvements wherethese had been identified. For example, the practice had workedwith the local Clinical Commissioning Group (CCG) to improveaccess to services at weekends. They had pioneered GP andadvanced nurse practitioner (ANP) appointments at PontefractGeneral Infirmary (A common venue where patients go to theaccident and emergency department). They had written thebusiness case, managed the pilot and assumed informationgovernance responsibility. GPs and advanced nurse practitioners(ANP) from the practice had help to fulfil the rota for these clinics.The GPs told us this had reduced attendance at accident andemergency.

The practice offered separate advice lines for children and thosewith long term conditions during opening hours. These were staffedby the ANPs. This enabled patients to access clinical support andadvice and where necessary and appropriate be prescribedmedicines. Patients said they found this a very useful service.

It acted on suggestions for improvements and changed the way itdelivered services in response to feedback from the patientparticipation group (PPG).

Patients told us it was easy to get an appointment with a named GPor a GP of choice, and urgent appointments were available on thesame day. The practice had good facilities and was well equipped totreat patients and meet their needs. Information about how tocomplain was available and easy to understand, and the practiceresponded quickly when issues were raised. Learning fromcomplaints was shared with staff and other stakeholders.

Outstanding –

Are services well-led?The practice is rated as outstanding for being well-led. It had a clearvision with quality and safety as its top priority. The strategy todeliver this vision had been produced with stakeholders and wasregularly reviewed and discussed with staff. High standards werepromoted and owned by all practice staff with evidence of excellent

Outstanding –

Summary of findings


team working across all roles. Governance and performancemanagement arrangements had been proactively reviewed andtook account of current models of best practice. Outcomes ofpractice based clinical audits were shared locally and nationally.The practice was involved in a number of innovative schemes toimprove outcomes for patients within their practice and the locality.The practice carried out proactive succession planning. There was ahigh level of constructive engagement with staff and a high level ofstaff satisfaction. The practice gathered feedback from patients andit had an active patient participation group (PPG).

Summary of findings


The six population groups and what we foundWe always inspect the quality of care for these six population groups.

Older peopleThe practice is rated as good for the care of older people. Nationallyreported data showed that outcomes for patients were good forconditions commonly found in older people. The practice offeredproactive, personalised care to meet the needs of the older peoplein its population. It was responsive to the needs of older people, andoffered home visits and rapid access appointments for those withenhanced needs. The practice provided weekly GP and advancednurse practitioner visits to a local care home.

The practice operated an advice line for patients and access to weekend appointments at the local hospital.

Flu vaccination rates were one of the highest in the area.

Good –––

People with long term conditionsThe practice is rated as outstanding for the care of people withlong-term conditions. Nursing staff had lead roles in chronic diseasemanagement and patients at risk of hospital admission wereidentified as a priority. Longer appointments and home visits wereavailable when needed. All these patients had a named GP and astructured annual review to check that their health and medicationneeds were being met. For those people with the most complexneeds, the named GP worked with relevant health and careprofessionals to deliver a multidisciplinary package of care.

The practice operated an advice line for patients and access to weekend appointments at the local hospital.

Flu vaccination rates were one of the highest in the area. Themajority of patients with three or more long term conditions had acare plan.

There were robust recall systems in place managed by dedicatedclinical and non-clinical staff for each area. The practice held specificclinics for patients with more than one long term condition so theyonly had to attend once for their reviews. A walk-in blood test clinicwas provided three times per week.

Clinical audits were used to improve the outcomes for patients withlong term conditions. Outcomes of audits had been widely sharedboth locally and nationally.

Outstanding –

Families, children and young peopleThe practice is rated as outstanding for the care of families, childrenand young people. There were systems in place to identify andfollow up children living in disadvantaged circumstances and who

Outstanding –

Summary of findings


were at risk. The advanced nurse practitioner with the lead role forsafeguarding worked closely with the health visitor and otheragencies. Childhood immunisation rates for the vaccinations givenwere higher than local CCG averages. The practice had worked wellwith the local travelling community and had provided animmunisation programme for children living in these circumstanceswithin their own environment. Patients told us that children andyoung people were treated in an age-appropriate way and wererecognised as individuals, and we saw evidence to confirm this.Appointments were available outside of school hours and thepremises were suitable for children and babies.

The practice had identified a gap in the sexual health service in thearea and services had been developed to improve access to adviceand support, particularly for young people.

There were a number of positive comments about the care andtreatment of children in respect of access to urgent appointmentsand the caring attitude of reception and clinical staff. The practicehad developed a telephone advice line for parents giving them quickand easy access to clinical support during practice opening hours.

Working age people (including those recently retired andstudents)The practice is rated as good for the care of working-age people(including those recently retired and students). The needs of theworking age population, those recently retired and students hadbeen identified and the practice had adjusted the services it offeredto ensure these were accessible, flexible and offered continuity ofcare. The practice was proactive in offering online services as well asa full range of health promotion and screening that reflected theneeds for this age group.

The appointment system was flexible and provided extended hoursand walk-in blood test clinics. A telephone advice line was alsoprovided which gave patients quick and easy access to clinicaladvice and support.

Good –––

People whose circumstances may make them vulnerableThe practice is rated as outstanding for the care of people whosecircumstances may make them vulnerable. The practice held aregister of patients living in vulnerable circumstances includingthose with a learning disability. The practice had three nurse clinicalleads and a dedicated administration person for learning disabilitypatients. Annual health reviews were completed for these patientsand care and treatment could be provided in the patient’s ownhome where this was beneficial and assisted in engaging patients tohave appropriate care. Ferrybridge surgeries were accredited as a“Safer Place” which is a scheme to provide a safe haven for

Outstanding –

Summary of findings


vulnerable patients lost in the community. The practice had workedwell with the local travelling community and had provided animmunisation programme for children living in these circumstanceswithin their own environment. The practice provided in houseservices to provide care and treatment for patients with misuse ofdrug and alcohol related needs.

The practice regularly worked with multi-disciplinary teams in thecase management of vulnerable people. It had told vulnerablepatients about how to access various support groups and voluntaryorganisations. There were robust systems in place to safeguardchildren and adults whose circumstances may make themvulnerable. Staff knew how to recognise signs of abuse in vulnerableadults and children. Staff were aware of their responsibilitiesregarding information sharing, documentation of safeguardingconcerns and how to contact relevant agencies in normal workinghours and out of hours.

People experiencing poor mental health (including peoplewith dementia)The practice is rated as good for the care of people experiencingpoor mental health (including people with dementia). The practiceregularly worked with multi-disciplinary teams in the casemanagement of people experiencing poor mental health, includingthose with dementia. It carried out advance care planning forpatients with dementia. Performance for mental health relatedindicators was 100% which was 5.8 percentage points above CCGaverage and 9.6 percentage points above England average.

The practice had told patients experiencing poor mental healthabout how to access various support groups and voluntaryorganisations. It had a system in place to follow up patients who hadattended accident and emergency (A and E) where they may havebeen experiencing poor mental health.

Good –––

Summary of findings


What people who use the service sayThe national GP patient survey results published on 4July 2015 for the most recent data showed the practicewas performing well above local and national averages ina number of areas. There were 307 survey formsdistributed for Ferrybridge Medical Centre and 107 formswere returned. This is a response rate of 34.9%. Resultsincluded;

• 86.4% found it easy to get through to this surgery byphone compared with a CCG average of 71.6% and anational average of 74.4%.

• 87.8% found the receptionists at this surgery helpfulcompared with a CCG average of 86.6% and a nationalaverage of 86.9%.

• 49% with a preferred GP usually get to see or speak tothat GP compared with a CCG average of 53.2% and anational average of 60.5%.

• 88.3% were able to get an appointment to see orspeak to someone the last time they tried comparedwith a CCG average of 85% and a national average of85.4%.

• 96.3% said the last appointment they got wasconvenient compared with a CCG average of 93.4%and a national average of 91.8%.

• 81.2% described their experience of making anappointment as good compared with a CCG average of73.3% and a national average of 73.8%.

• 79.6% usually wait 15 minutes or less after theirappointment time to be seen compared with a CCGaverage of 71.3% and a national average of 65.2%.

• 75.5% felt they didn’t normally have to wait too long tobe seen compared with a CCG average of 62.7% and anational average of 57.8%.

As part of our inspection we asked for CQC commentcards to be completed by patients prior to our inspection.We received 16 comment cards all of which were positiveabout the standard of care and treatment received. Wealso spoke with 14 patients on the day of the inspectionincluding a member of the patient participation group(PPG). Other than comments from one person thecomments we received were very positive about theirexperience of the service. Patient’s told us staff were verycaring and professional. They told us the staff took theirtime to listen to them and explain treatments. They saidthey were treated with dignity and respect and they saidthe reception staff were helpful and polite. They also toldus they found the practice to be clean and tidy. Patientswere very positive about the appointment system andsaid they could always access a same day urgentappointment. They told us they received continuity intheir care and could see a GP of their choice within anacceptable timeframe. There were a number of positivecomments about the care and treatment of children inrespect of access to urgent appointments and the caringattitude of reception and clinical staff..

Summary of findings


Our inspection teamOur inspection team was led by:

Our inspection team was led by a CQC Lead Inspector.The team included a GP specialist advisor, pharmacistspecialist advisor, a practice manager specialist advisor,nurse specialist advisor and an expert by experience.

Background to FerrybridgeMedical CentreFerrybridge Medical Centre is situated within a purposebuilt surgery in Knottingly, Wakefield known as BeauforthHouse. Beauforth House has a separate building, known asthe High Street, where additional surgery space can beutilised for clinics as required. This building is situated ashort distance across from Beauforth House car park. Wevisited both buildings during this inspection. There is also abranch surgery at The Surgery, Anne Sharpe Centre, StEdwards Close, Byram, WF11 9NT. We visited this branchsurgery as part of this inspection.

The practice provides Personal Medical Services (PMS) for9,911 patients across the three sites in the NHS WakefieldClinical Commissioning Group (CCG) area.

There are five GP partners, and four salaried GPs, fouradvanced nurse practitioners, one specialist practitionernurse, two practice nurses and three health care assistantswho all work across both sites. There is a largeadministration team who also work across each siteincluding a practice manager, reception manger and ITmanager. The practice manager is responsible for all threesites.

The practice is open at the following times across the threesites:

• Beauforth House - Reception opening times are 8am to6.30pm Monday to Friday. Surgeries are between 8.30amand 6.30pm Monday to Friday.

• High Street – Reception opening times are 8am to6.30pm, Monday to Friday.This building holds surgeriesand clinics between 8.30am and 6pm Monday to Fridayas required and provides additional space to BeauforthHouse.

• Byram – Reception opening times are 8.15am to11.30am and 2.30pm to 6.30pm Monday to Friday.Surgery opening times are from 8.30am to 11.30am and2.30pm to 6.30pm Monday to Friday excludingWednesdays. On Wednesdays, Byram closes at 11.30am.

Extended Hours are provided 8.30am to 11.30am everySaturday at Beauforth House. Walk-in blood test clinics areavailable at the High Street building every Monday 1.30pmto 4.15pm, Tuesday 8am to 11.30am and Thursday 8am to11.30am.

Longer appointments are available for those who needthem and home visits and telephone consultations areavailable as required.

The practice provides a dispensing service to 2,700 of itspatients from both Beauforth House and Byram surgeries.

Out of hours services are provided by Local Care Direct.Calls are diverted to this service when the practice isclosed.

The practice also provided training in general practice fordoctors and medical and nursing students.

FFerrerrybridgybridgee MedicMedicalal CentrCentreeDetailed findings


The practice is registered to provide the following regulatedactivities; maternity and midwifery services; surgicalprocedures, family planning, diagnostic and screeningprocedures and treatment of disease, disorder or injury.

Why we carried out thisinspectionWe inspected this service as part of our newcomprehensive inspection programme under Section 60 ofthe Health and Social Care Act 2008 which is part of ourregulatory functions. This inspection was planned to checkwhether the registered provider is meeting the legalrequirements and regulations associated with the Healthand Social Care Act 2008, to look at the overall quality ofthe service, and to provide a rating for the service under theCare Act 2014.

Please note when referring to information throughout thisreport, for example any reference to the Quality andOutcomes Framework data, this relates to the most recentinformation available to the CQC at the time.

How we carried out thisinspectionTo get to the heart of patients’ experiences of care andtreatment, we always ask the following five questions:

• Is it safe?• Is it effective?• Is it caring?

• Is it responsive to people’s needs?• Is it well-led?

We also looked at how well services are provided forspecific groups of people and what good care looks like forthem. The population groups are:

• Older people• People with long-term conditions• Families, children and young people• Working age people (including those recently retired

and students)• People whose circumstances may make them

vulnerable• People experiencing poor mental health (including

people with dementia)

Before visiting, we reviewed a range of information we holdabout the practice and asked other organisations, such asthe NHS Wakefield Clinical Commissioning Group (CCG), toshare what they knew.

We carried out an announced visit on 8 September 2015.During our visit we spoke with a range of staff including sixGPs, two advanced nurse practitioners, three practicenurses, health care assistant, practice manager, IT managerand six administration staff. We also spoke with 14 patientsincluding a member of the PPG.

We observed communication and interactions betweenstaff and patients, both face to face and on the telephonewithin the reception area. We reviewed 16 CQC patientcomment cards where patients had shared their views andexperiences of the practice. We also reviewed recordsrelating to the management of the practice.

Detailed findings


Our findingsSafe track record and learning

There was an open and transparent approach and a systemin place for reporting and recording significant events.People affected by significant events received a timely andsincere apology and were told about actions taken toimprove care. Staff told us they would inform the practicemanager of any incidents and there was also a recordingform available on the practice’s computer system. Thepractice carried out a root cause analysis of significantevents and a quarterly report was completed anddiscussed at practice meetings.

We reviewed safety records, incident reports and minutesof meetings where these were discussed. Lessons wereshared when an incident had occurred to make sure actionwas taken to improve safety in the practice. For example,there had been 15 incident’s recorded as significant eventsover the last 12 months. One incident related to a vaccine.Actions and learning were clearly recorded and practicehad been reviewed and changed to mitigate risk.

Safety was monitored using information from a range ofsources, including National Institute for Health and CareExcellence (NICE) guidance. This enabled staff tounderstand risks and gave a clear, accurate and currentpicture of safety. The practice used the National Reportingand Learning System (NRLS) electronic form to reportpatient safety incidents.

The practice had a good and robust system for dealing withmedicine alerts. These were cascaded to both dispensariesand there was an audit trail to show that they had beendealt with appropriately.

Dispensers told us near misses or errors were reportedcentrally to the supervisor and logged on the intranet.However, we found there was no feedback loop fordispensary staff to share best practice or to haveinvolvement in performing root cause analysis.

Overview of safety systems and processes

The practice had clearly defined and embedded systems,processes and practices in place to keep people safe, whichincluded:

• Arrangements were in place to safeguard adults andchildren from abuse that reflected relevant legislation

and local requirements and policies were accessible toall staff. The policies clearly outlined who to contact forfurther guidance if staff had concerns about a patient’swelfare. One of the advanced nurse practitioners (ANP)was the lead member of staff for safeguarding. Theyworked closely with the health visitor and had goodlinks with other teams such as the Police, domesticabuse team and multi-agency safeguarding hub. Thehealth visitor attended monthly clinical meetings todiscuss safeguarding concerns. The health visitor told usworking together with the practice had improved thesupport for vulnerable children and families. The ANPalso attended local Clinical Commissioning Group (CCG)meetings for safeguarding leads and disseminatedinformation from these meetings to the practice team.The GPs attended safeguarding meetings when possibleand always provided reports where necessary for otheragencies. Staff demonstrated they understood theirresponsibilities and all had received training relevant totheir role. Training relating to current safeguardingthemes was also provided. For example, thesafeguarding lead and the health visitor were scheduledto provide joint training in September 2015 in femalegenital mutilation and child sexual exploitation. Therewas a clear system for recording and sharinginformation and the IT system was used to identifyvulnerable patients at risk of abuse.

• A notice was displayed in the waiting room, advisingpatients that staff would act as chaperones, if required.Nurses, healthcare assistant’s and some reception staffacted as chaperones. They had received training andhad a disclosure and barring check (DBS). (DBS checksidentify whether a person has a criminal record or is onan official list of people barred from working in roleswhere they may have contact with children or adultswho may be vulnerable).

• There were procedures in place for monitoring andmanaging risks to patient and staff safety. The practicehad a health and safety manager, a health and safetypolicy was available and staff had received training inmatters relating to health and safety. The practice hadup to date fire risk assessments and regular fire drillswere carried out. All electrical equipment was checkedto ensure the equipment was safe to use and clinicalequipment was checked to ensure it was working

Are services safe?

Good –––


properly. The practice also had a variety of other riskassessments in place to monitor safety of the premisessuch as control of substances hazardous to health,infection control and legionella.

• Appropriate standards of cleanliness and hygiene werefollowed. We observed the premises to be clean andtidy. A practice nurse was the infection control clinicallead who liaised with the local infection preventionteams to keep up to date with best practice. There wasan infection control protocol in place and staff hadreceived up to date training. Annual infection controlaudits were undertaken and we saw evidence thataction was taken to address any improvementsidentified as a result. The last audit had been completedin April 2015 with 89% compliance. The main areas ofnon-compliance identified were the lack of a designateddirty utility room for which options were beingconsidered and also the lack of a hand basin in thecleaners room and where installation of a sink wasplanned. Other areas identified had been actioned. Theinfection control lead had provided training to thewhole team on infection control and had addressed theissues from the audit with staff.

• The arrangements for managing medicines, includingemergency drugs and vaccines, in the practice keptpatients safe (including obtaining, prescribing,recording, handling and storing). For example, thecontrolled drugs cabinet provided safe and securestorage to current guidance standards and there wereprocesses in place to keep keys secure. When wechecked, the controlled drug inventory balanced withthe records and these were accurate and complete. Thesystems to monitor the temperature of the fridges usedfor storing vaccines were robust and required thetemperature to be logged on the computer twice daily.The computer system had an alarm in order to promptstaff to complete this task. Regular medication auditswere carried out with the support of the local CCGpharmacy teams to ensure the practice was in line withbest practice guidelines for safe prescribing.Prescription pads were securely stored and there weresystems in place to monitor their use.

• The practice had a dispensary at Beauforth House andByram surgery. The medication in both dispensaries waswell organised with evidence of stock rotation. Alldispensary staff had relevant NVQ level twoqualifications. The dispensaries procedures andstandard operating procedures were up to date and

available on the intranet. The practice had a robustsystem for dealing with medication alerts. These werecascaded to both dispensaries and there was an audittrail to show that they had been dealt withappropriately. We saw some areas for improvement inthe dispensaries. The dispensary at Byram waspositioned in the corridor between the waiting roomand surgeries and the dispenser had the task of alsomanning the reception desk. This meant the dispensarywas unmanned for some of the time and could not beobserved by the dispenser if dealing with a patient atthe reception desk. We saw the dispensary had the doorleft open potentially providing unobserved access forpatients. We highlighted this to the practice duringthe inspection and they assurred us us they wouldimprove the security of this area. Patients could returnwaste medication to Byram where it was transportedback to Beauforth House for destruction. Thesemedicines were not logged on receipt at Byram toensure a complete audit trail. Dispensers told us nearmisses or errors were reported centrally to thesupervisor for investigation and logged on the intranetsystem. However, we found there was no feedback loopfor dispensary staff to share best practice or perform anyroot cause analysis.

• Recruitment checks were carried out and the four fileswe reviewed showed that appropriate recruitmentchecks had been undertaken prior to employment. Forexample, proof of identification, references,qualifications, registration with the appropriateprofessional body and the appropriate checks throughthe Disclosure and Barring Service.

• Arrangements were in place for planning andmonitoring the number of staff and mix of staff neededto meet patients’ needs. There was a rota system inplace for all the different staffing groups to ensure thatenough staff were on duty. Staff were all happy workingat the practice and a number had worked there formany years. However, we had some comments that theadministration staff team were short staffed and theyhad to increasingly work overtime to provide cover. Theytold us recruitment was ongoing but seemed to take toolong.

Arrangements to deal with emergencies and majorincidents

There was an instant messaging system on the computersin all the consultation and treatment rooms which alerted

Are services safe?

Good –––


staff to any emergency. All staff received annual basic lifesupport training and there were emergency medicinesavailable in the treatment room. The practice had adefibrillator available on the premises and oxygen withadult and children’s masks. However we did note that onedefibrillator was shared between Beauforth House and theHigh Street sites. The practice manager provided a riskassessment after the inspection and this identified thatwhile access to the defibrillator met current guidelines theywere going to purchase additional equipment. There was

also a first aid kit and an accident book available.Emergency medicines were easily accessible to staff in asecure area of the practice and staff knew of their location.All the medicines we checked were in date and fit for use.

The practice had a comprehensive business continuity planin place for major incidents such as power failure orbuilding damage. The plan included emergency contactnumbers for staff.

Are services safe?

Good –––


Our findingsEffective needs assessment

The practice carried out assessments and treatment in linerelevant and current evidence based guidance andstandards, including National Institute for Health and CareExcellence (NICE) best practice guidelines. The practice hadsystems in place to ensure all clinical staff were kept up todate. The practice had access to guidelines from NICE andused this information to develop how care and treatmentwas delivered to meet needs. For example, the practice hadcompleted a clinical audit, following guidelines beingpublished by NICE which recommended that every patientwith the skin condition, Psoriasis, should have acardiovascular risk assessment. The NICE guidance hadidentified that there was a significantly increased incidenceof stroke, heart disease and diabetes in this group ofpatients. The practice identified the patients with this skincondition that had not already attended for a NHS healthcheck and invited them to attend. A number of patientswith risk factors requiring interventions to minimise therisks of stroke and heart attacks were identified andtreatment was commenced. The outcomes of the auditwere shared within the practice, locally with the CCG andnationally in a published paper in the British Journal ofGeneral Practice in September 2015.

Patients on the unplanned admissions register who were75 years of age plus and the majority those with three ormore long term conditions had a personalised care plan.Care plans reflected best practice and were reviewed atthree, six and 12 monthly intervals. We were told that if thepatient was not able to attend the practice then the nurseswould visit the patient in their home or care home toensure their involvement in developing the care plan. Thepractice was involved in a local pilot scheme relating tounplanned admissions avoidance whereby a GP and anadvanced nurse practitioner (ANP) conducted weekly visitsto a local care home. This enabled these patients to beinvolved in their care planning. There were also proceduresin place for following up patients who had been admittedto hospital.

Management, monitoring and improving outcomes forpeople

The practice participated in the Quality and OutcomesFramework (QOF). (This is a system intended to improve

the quality of general practice and reward good practice).The practice used the information collected for the QOFand performance against national screening programmesto monitor outcomes for patients. Data showed thepractice had attained 96.8% of the total number of pointsavailable, with 8.4% exception reporting. This practice wasnot an outlier for any QOF (or other national) clinicaltargets. Data from 2013/14 showed;

• Performance for diabetes related indicators was similarto the CCG and national average at 91.2% which was 0.2percentage points below CCG average and 0.1percentage points above England average

• The percentage of patients with hypertension havingregular blood pressure tests was 82.4% which was 1.2percentage points below CCG average and 0.7percentage points below England average.

• Performance for mental health related indicators was100% which was 5.8 percentage points above CCGaverage and 9.6 percentage points above Englandaverage.

• Performance for hypertension indicators was 86.5%which was 2.9 percentage points below CCG averageand 1.9 percentage points below England average.

Clinical audits were carried out to demonstrate qualityimprovement and all relevant staff were involved toimprove care and treatment and people’s outcomes. Thepractice participated in applicable local audits, nationalbenchmarking, accreditation, peer review and research.Findings were used by the practice to improve services. Forexample:

• The practice was working with the CCG and wascurrently achieving six of the ten quality prescribingindicators. We saw they had used clinical audits toachieve these targets and they were on track to achieveall ten targets by the end of the year. The practice hadalso accessed prescription data to monitor prescribinghabits of the clinicians. We saw action had been takenwhere prescribing was not in line with local/nationalpolicy.

• An audit on the care and treatment of patients withurinary tract infections had been completed. This hadlooked at differing practices among the clinicians inrelation to care and treatment. From this study a new

Are services effective?(for example, treatment is effective)

Good –––


protocol had been developed and implemented toensure best practice. We were told this area would bereviewed in twelve months to look at how compliant thepractice had been with the new protocol.

• The practice was involved with the Aspire NationalStudy with Leeds University as practice figures forstrokes were high indicating possible undiagnosedhypertension. They found detection rates forhypertension were good but outcomes where therewere difficulties regulating blood pressure were lesspositive. The Aspire study provided an interactiveprogramme from which the practice could get expertadvice on care and treatment.

• The practice had also recently introduced atrialfibrillation testing using the Mydiagnostic tool toimprove detection of atrial fibrillation and subsequenttherapy in line with NICE guidelines.

• The nursing team were also involved in clinical audits,one nurse told us they conducted audits of smear testsfor effectiveness and said they were involved ingathering information for other clinical audits held inthe practice. They told us about an audit related to apilot scheme which involved telephone reviews forpatients with Asthma. The practice specialist nursepractitioner had presented the outcomes of this at aRespiratory network meeting. They said an annual recallsystem had been implemented which had improvedpatient attendance for asthma reviews. Theindependent nurse prescribers undertook an annualaudit of their own prescribing practice and this auditwas then peer reviewed at the CCG non-medicalprescribing group.

The practice had good systems in place to monitor patientswith long term conditions. For example, the practice had adocumented procedure to ensure effective recalls ofpatients with long term conditions. This identified themember of staff responsible for each related task andincluded the procedure for contacting patients who did notattend. The practice held specific clinics for patients withmore than one long term condition so they only had toattend once for their reviews.

The practice also had a good system for monitoringpatients prescribed high risk disease-modifyinganti-rheumatic drugs (DMARD’s). For example, this wasdealt with by one clinician who ensured all necessary

blood tests were conducted. This prevented patientsreceiving repeat medication without review. Triggers werealso in place to highlight anomalies in blood results inorder to prompt a review.

The practice held monthly case reviews of patientsregistered at the practice that had died.

Effective staffing

Staff had the skills, knowledge and experience to delivereffective care and treatment. The practice provided abovenational average, whole time equivalent, clinical staffinglevels at 1.7 per 1,000 patients compared to nationalaverage of 1.6 per 1,000.

The practice had an induction programme for newlyappointed non-clinical members of staff that covered suchtopics as safeguarding, fire safety, health and safety andconfidentiality. The learning needs of staff were identifiedthrough a system of appraisals, meetings and reviews ofpractice development needs. Staff had access toappropriate training to meet these learning needs and tocover the scope of their work. This included ongoingsupport during sessions, one-to-one meetings, appraisals,coaching and mentoring, clinical supervision andfacilitation and support for the revalidation of doctors. Allstaff had had an appraisal within the last 12 months.

All staff received refresher training that included:safeguarding, fire procedures, basic life support andinformation governance awareness. Staff had access to andmade use of e-learning training modules and in-housetraining.

GPs confirmed there was opportunity for training anddevelopment and they said they were well supported. Theytold us they attended monthly training sessions within thepractice and at the CCG. The practice also provided trainingin general practice for doctors and medical students.

There was a skilled nursing team at the practice led by anANP. We found all nurses were trained in specific diseaseareas and were encouraged to attend updates at leastannually. Training needs and prioritisation of trainingneeds and desires were discussed at the weekly nursemeeting.

There was a clear and robust system of training andsupervision for the health care assistant (HCA) team. All ofthe HCAs were included in the training programme fornurses as appropriate. They had their own training log and


Good –––


were supported by a mentor. All HCAs received formaltraining on phlebotomy, had annual updates on flu andimmunisation and were also encouraged to attend theannual HCA conference. All HCAs had attended study dayson hypertension, NHS health checks and lifestylemodification and they had attended Wakefield CCG’sbespoke training for HCAs on managing wound care. TwoHCAs had also received further training on immunisationfor flu, shingles and vitamin B12. The HCAs were supportedby and had access to a registered nurse. They worked totheir pateint specific directives which stipulated that aregistered member of staff had to be on the premises ifthey are giving any immunisations/injections.

We found there was excellent workforce planning. Therewas a good understanding of the challenges facing thegeneral practice nurse workforce and the lead nurse hadbeen instrumental in bringing undergraduate nursestudents for placements within the practice. The latestpractice nurse recruit was a newly qualified nurse and wesaw they had received a robust training programme. Thishad included attendance at a practice nurse course andtraining in cytology, asthma, immunisations, coronaryheart disease and diabetes.

The nursing team mentor for student nurses and threeother practice nurses had attended mentor updates in2015 and all students had a mentor.

The practice was very active in the local CCG and the leadnurse was involved with external activities, for example,they were the chairperson of the non-medical prescribinggroup.

Coordinating patient care and information sharing

The information needed to plan and deliver care andtreatment was available to relevant staff in a timely andaccessible way through the practice’s patient record systemand its intranet system. This included care and riskassessments, care plans, medical records and test results.Information such as NHS patient information leaflets werealso available. All relevant information was shared withother services in a timely way, for example when peoplewere referred to other services. A visitor from externalagencies told us there was good communication with thepractice.

Staff worked together and with other health and social careservices to understand and meet the range and complexityof people’s needs and to assess and plan ongoing care and

treatment. This included when people moved betweenservices, including when they were referred, or after theyare discharged from hospital. We saw evidence thatmulti-disciplinary team meetings took place on a monthlybasis and that care plans were routinely reviewed andupdated.

Consent to care and treatment

Patients’ consent to care and treatment was always soughtin line with legislation and guidance. Staff understood therelevant consent and decision-making requirements oflegislation and guidance, including the Mental Capacity Act2005 and had received training in relevant areas. Whenproviding care and treatment for children and youngpeople, assessments of capacity to consent were alsocarried out in line with relevant guidance. We saw atemplate for sexual health matters which had a section toaddress Fraser guidelines and a section for assessing Gillickcompetence (set of criteria which must be applied whenmedical practitioners are offering contraceptive services tounder 16s without parental knowledge or permission) anda section for consent. Where a patient’s mental capacity toconsent to care or treatment was unclear the GP or nurseassessed the patient’s capacity and, where appropriate,recorded the outcome of the assessment. The process forseeking consent was monitored through training andmeetings to ensure this met the practice’s responsibilitieswithin legislation and followed relevant national guidance.

Health promotion and prevention

Patients who may be in need of extra support wereidentified by the practice. These included patients in thelast 12 months of their lives, carers, those at risk ofdeveloping a long-term condition and those requiringadvice on their diet, smoking cessation and drug andalcohol misuse. Patients were then signposted to therelevant service. The practice also provided in houseservices for drug and alcohol misuse and dermatology.

The practice had three nurse clinical leads and a dedicatedadministration person for learning disability patients.Annual health reviews were completed for these patients.Care and treatment could be provided in the patient’s ownhome where this was beneficial and assisted in engagingpatients to have appropriate care. For example, one patientrequired a cervical smear but due to anxiety could not havethis performed at the surgery. The nurses arranged for thisto be completed in the person’s own home.


Good –––


The practice had a comprehensive screening programme.The practice’s uptake for the cervical screening programmewas 80.86%, which was comparable the national average of81.88%. There was a policy to offer telephone reminders forpatients who did not attend for their cervical screeningtest. The practice also encouraged its patients to attendnational screening programmes for bowel and breastcancer screening.

Childhood immunisation rates for the vaccinations givenwere slightly higher than CCG averages. For example,childhood immunisation rates for the vaccinations given tounder two year olds ranged from 94.8% to 99.2% and fiveyear olds from 95.1% to 98%. Comparable CCG rates were88.7% to 98% and 91.9% to 95.1%. Flu vaccination rates forthe over 65s were 80.25% and at risk groups 62.17 %. Thesewere above national averages of 73.24% and 52.29%.Nurses from the practice had provided a child-hoodvaccination service to a local travelling community.Through this trust was gained with a family whosubsequently began to attend the surgery.

Patients had access to appropriate health assessments andchecks. These included health checks for new patients andNHS health checks for people aged 40–74. To support this,the practice provided walk-in phlebotomy clinics threedays per week. Appropriate follow-ups on the outcomes ofhealth assessments and checks were made whereabnormalities or risk factors were identified.

The practice had identified a gap in the sexual healthservice in the area. An advanced nurse practitioner (ANP)was recruited to improve access to advice and support

particularly for young people. The nurse had worked withthe Terence Higgins Trust to bring in a weekly youth clinicfor patients under the age of 18 years. The clinic ran onceper week for two hours on a drop-in basis. The healthadvisor and sexual health nurse initially worked in thisclinic but this was now also supported by the other practicenurses. The nurse told us this clinic was now well-knownlocally and well used. The clinic offered screening forsexually transmitted diseases such as chlamydia. They alsooffered rapid access HIV thumb prick tests and if positive,bloods were then taken immediately.

The practice had supported a member of staff to completetraining to enable them to implement the use of socialmedia as a tool to engage with patients. They had set up aFacebook page and Twitter account. They used thesesystems to give generic health information and to promotehealth awareness.

The practice had supported a health promotion day at alocal supermarket to identify patients in the area who mayhave an undiagnosed condition no matter with whichsurgery they were registered. This had been arrangedbased on evidence of higher prevalence of hypertensionand stroke in patients locally. Information had been sharedwith the patients’ surgery with their consent.

The practice was also in the process of implementing the“All together better” practice health champions scheme.This involved the patients setting up interest groups andaimed to combat social isolation amongst the elderly. Theyhad received a positive response from the patients with 52expressing interest in becoming involved.


Good –––


Our findingsRespect, dignity, compassion and empathy

We observed throughout the inspection that members ofstaff were courteous and very helpful to patients bothattending at the reception desk and on the telephone andthat people were treated with dignity and respect. Curtainswere provided in consulting rooms so that patients’ privacyand dignity was maintained during examinations,investigations and treatments. We noted that consultationand treatment room doors were closed duringconsultations and that conversations taking place in theserooms could not be overheard. Reception staff knew whenpatients wanted to discuss sensitive issues or appeareddistressed they could offer them a private room to discusstheir needs.

All of the 16 patient CQC comment cards we received werepositive about the service they experienced. Patients saidthey felt the practice offered an excellent service and staffwere helpful, caring and treated them with dignity andrespect. We also spoke with a member of the patientparticipation group (PPG) on the day of our inspection.They told us they were satisfied with the care provided bythe practice and said their dignity and privacy wasrespected. Comment cards highlighted that staffresponded compassionately when they needed help andprovided support when required.

Results from the national GP patient survey showedpatients were satisfied with how they were treated and thatthis was with compassion, dignity and respect. The practicewas similar to CCG and national averages for its satisfactionscores on consultations with doctors and nurses. Forexample:

• 89.8% said the GP was good at listening to themcompared to the CCG average of 88.8% and nationalaverage of 88.6%.

• 86.9% said the GP gave them enough time compared tothe CCG average of 87.7% and national average of86.8%.

• 91.4% said they had confidence and trust in the last GPthey saw compared to the CCG average of 96% andnational average of 95.3%.

• 92.1% said the last GP they spoke to was good attreating them with care and concern compared to theCCG average of 86.1% and national average of 85.1%.

• 88.4% said the last nurse they spoke to was good attreating them with care and concern compared to theCCG average of 90% and national average of 90.4%.

• 87.8% patients said they found the receptionists at thepractice helpful compared to the CCG average of 86.6%and national average of 86.9%.

Care planning and involvement in decisions aboutcare and treatment

Patients we spoke with told us that health issues werediscussed with them and they felt involved in decisionmaking about the care and treatment they received. Theyalso told us they felt listened to and supported by staff andhad sufficient time during consultations to make aninformed decision about the choice of treatment availableto them. Patient feedback on the comment cards wereceived was also positive and aligned with these views.The nurses and GPs offered home visits for patients whorequired these to ensure they were involved in their careplans and received the care they required.

Results from the national GP patient survey we reviewedshowed patients responded positively to questions abouttheir involvement in planning and making decisions abouttheir care and treatment and results were above local andnational averages. For example:

• 90.5% said the last GP they saw was good at explainingtests and treatments compared to the CCG average of86.3% and national average of 86.3%.

• 83.2% said the last GP they saw was good at involvingthem in decisions about their care compared to the CCGaverage of 81.3% and national average of 81.5%.

Staff told us that translation services were available forpatients who did not have English as a first language. Wesaw notices in the reception areas informing patients thisservice was available. The practice website had a translatepage function and information leaflets were available indifferent languages and easy to read formats. For example,we saw leaflets in different languages relating to cytologyand breast examination.

Patient and carer support to cope emotionally withcare and treatment

Notices in the patient waiting room told patients how toaccess a number of support groups and organisations.

The practice’s computer system alerted GPs if a patient wasalso a carer and the practice held a register of all people/

Are services caring?

Good –––


patients who were carers. Written information wasavailable for carers to ensure they understood the variousavenues of support available to them such as the localcarers association.

Staff told us that if families had suffered bereavement, theywould be advised on bereavement counselling serves andthe practice would send them a sympathy card.

Ferry bridge surgeries were accredited as a “Safer Place”which is a scheme to provide a safe haven for vulnerablepeople lost in the community.

Care and treatment could be provided in the patient’s ownhome where this was beneficial and assisted in engagingpatients to receive appropriate care. For example, whereone patient required treatment but due to anxiety couldnot attend the surgery, the nurses arranged for this to becompleted in the persons own home.

Are services caring?

Good –––


Our findingsResponding to and meeting people’s needs

The practice worked with the local CCG to plan services andto improve outcomes for patients in the area. For example,the practice had pioneered GP and advanced nursepractitioner (ANP) appointments at Pontefract GeneralInfirmary, Saturday and Sundays, 11am to 4pm for patientsto improve access and reduce the burden on the localaccident and emergency department. They had written thebusiness case, managed the pilot and assumedinformation governance responsibility. GPs and ANPs fromthe practice had filled the rota for these clinics.

Services were planned and delivered to take into accountthe needs of different patient groups and to help provideflexibility, choice and continuity of care. For example:

• The practice offered extended hours on a Saturdaymorning from 8.30am to 11.30am at Beauforth Housefor routine pre booked appointments patients whocould not attend during normal opening hours. Drop-inphlebotomy services were also available at the HighStreet building three times per week.

• The practice had maximised the skill mix within thenursing team which had made a positive impact onpatient access to services.

• There were longer appointments and home visitsavailable for people with a learning disability.

• Home visits were available for older patients andpatients who would benefit from these.

• Urgent access appointments were available for childrenand those with serious medical conditions.

• There were disabled facilities, hearing loop andtranslation services available at all three sites. Therewas extensive use of braille throughout BeauforthHouse.

• The web site had a translate page function, theelectronic patient check-in system was available indifferent languages, interpreter services were availableand information leaflets were available in easy to readformats.

• The practice had worked with the local travellingcommunity to provide childhood vaccinations withintheir own environment.

Access to the service

The practice was open at the following times across thethree sites:

• Beauforth House - reception opening times were 8am to6.30pm Monday to Friday. Surgeries were between8.30am and 6.30pm Monday to Friday.

• High Street – reception opening times were 8am to6.30pm. Surgeries and clinics were held between8.30am and 6pm Monday to Friday.

• Byram – reception opening times were 8.15am -11.30amand 2.30pm -6.30pm Monday to Friday. Surgery openingtimes were from 8.30am to 11.30am and 2.30pm to6.30pm Monday to Friday excluding Wednesdays. OnWednesdays, Byram closed at 11.30 am.

Extended hours were provided 8.30am to 11.30am everySaturday at Beauforth House. Walk-in blood test clinicswere available at the High Street building every Monday1.30pm to 4.15pm, Tuesday 8am to 11.30am and Thursday8am to 11.30am.

In addition to pre-bookable appointments that could bebooked up to six weeks in advance, urgent appointmentswere also available for people that needed them.

The practice offered two separate advice lines duringopening hours, one for children and one for generalqueries. These were staffed by the ANPs and meant thatpatients could access clinical support and advice over thetelephone and, where necessary and appropriate, beprescribed medicines. Patients said they found this a veryuseful service.

People we spoke to on the day told us they were able to getappointments when they needed them. For example,patients told us they could get appointments the same dayand they could see a GP of their choice within a reasonabletimescale. One patient told us how the practice workedwith them to offer extended family appointments.

Results from the national GP patient survey showed thatpatient’s satisfaction with how they could access care andtreatment was much better than local and nationalaverages For example:

• 82.6% of patients were satisfied with the practice’sopening hours compared to the CCG average of 76%and national average of 75.7%.

• 86.4% patients said they could get through easily to thesurgery by phone compared to the CCG average of71.6% and national average of 74.4%.

Are services responsive to people’s needs?(for example, to feedback?)

Outstanding –


• 81.2% patients described their experience of making anappointment as good compared to the CCG average of73.3% and national average of 73.8%.

• 79.6% patients said they usually waited 15 minutes orless after their appointment time compared to the CCGaverage of 71.3% and national average of 65.2%.

Listening and learning from concerns and complaints

The practice had a system in place for handling complaintsand concerns. Its complaints policy and procedures were inline with recognised guidance and contractual obligationsfor GPs in England. There was a designated responsibleperson who handled all complaints in the practice.

We saw that information was available to help patientsunderstand the complaints system and was available in thepractice and on the website. Patients we spoke with wereaware of the process to follow if they wished to make acomplaint.

We found 19 complaints had been received in the last 12months. We found these were satisfactorily handled anddealt with in a timely way.

Lessons were learnt from concerns and complaints andaction was taken to as a result to improve the quality ofcare. Learning was disseminated via meetings. Forexample, where a patient had experienced difficulties withonline ordering and electronic transfer of prescriptions aninvestigation had been completed. Action had been takenin terms of addressing the error with the member of staffinvolved. The systems were monitored to ensure therewere no further problems.

Are services responsive to people’s needs?(for example, to feedback?)

Outstanding –


Our findingsVision and strategy

The practice had a clear vision to deliver high quality careand promote good outcomes for patients. Their aims andobjectives were documented in its statement of purposeand included providing a high standard of health care to allpatients, evolving health care services for patients in linewith clinical evidence of their emerging needs and to makepatients and carers an integral part of the decision makingabout health care. We found the aims and objectives werebeing achieved and were embedded within the culture ofthe practice. The practice had a robust strategy andsupporting business plans which reflected the vision andvalues and were these were regularly monitored.

Governance arrangements

The practice had a strong overarching governanceframework which supported the delivery of the strategyand good quality care. This outlined the structures andprocedures in place and ensured that:

• There was strong leadership in all areas of the practiceand a clear staffing structure. Staff were aware of theirown roles and responsibilities and worked well together.

• The practice carried out proactive succession planning.• There was excellent team work and the practice worked

well with others.• Education and training was well supported and given a

high priority within the practice.• Practice specific policies were implemented and were

available to all staff• There was a comprehensive understanding of the

performance of the practice• A programme of continuous clinical and internal audit

which is used to monitor quality and to makeimprovements

• There were robust arrangements for identifying,recording and managing risks, issues and implementingmitigating actions

Leadership, openness and transparency

The partners in the practice had the experience, capacityand capability to manage the practice and ensure highquality care. They prioritised safe, high quality andcompassionate care. The partners were visible in thepractice and staff told us that they were approachable and

always took the time to listen to all members of staff. Thepartners encouraged a culture of openness and honesty.The GP, nursing and administration teams were well led asindividual teams and they all worked closely together in acohesive manner.

Staff told us that regular team meetings were held andthere was an open culture within the practice. They saidthey had the opportunity to raise any issues at teammeetings and were confident in doing so and feltsupported if they did. We also noted that team away dayswere held. Staff said they felt respected, valued andsupported, particularly by the partners in the practice. Allstaff were involved in discussions about how to run anddevelop the practice, and the partners encouraged allmembers of staff to identify opportunities to improve theservice delivered by the practice.

Seeking and acting on feedback from patients, thepublic and staff

The practice encouraged and valued feedback frompatients, proactively gaining patients’ feedback andengaging patients in the delivery of the service. It hadgathered feedback from patients through the patientparticipation group (PPG) and through surveys andcomplaints received. The practice was in the process ofinitiating a detailed survey of patients in response to datafrom the national GP survey. This had indicated patientsmay not be fully satisfied with the continuity of careprovided. The survey was to ask patients specificinformation relating to this area in order to improve theservices provided.

There was a small but active PPG which met on a quarterlybasis. One member of the PPG said that while they foundthe practice to be excellent they thought the involvementof the PPG and communication with the practice could beimproved. They told us some action had been taken inrelation to suggestions the PPG had made. For example,they had suggested that the practices withheld number bechanged so patients could identify who was contactingthem via the telephone and this had been actioned.

The practice had also gathered feedback from staff throughstaff away days and generally through staff meetings,appraisals and discussion. Staff told us they would not

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Outstanding –


hesitate to give feedback and discuss any concerns orissues with colleagues and management. Staff told us theyfelt involved and engaged to improve how the practice wasrun.

Innovation

There was a strong focus on continuous learning andimprovement at all levels within the practice. The practiceteam was forward thinking and part of local pilot schemesto improve outcomes for patients in the area. For example,

• The lead nurse, as part of her master’s degree course,had set up a triage system in the practice. They said thisworked well initially, but after review with patients thishad evolved into an advice line service. There were twoadvice lines, one for general advice and one for parentsto ask advice in relation to their children’s health needs.These were staffed by the ANP and meant that patientscould access clinical support and advice and, wherenecessary and appropriate, be prescribed medicines.They had undertaken several service reviews of thepractice to ensure its effectiveness. The service wasoperated five days a week from 8am to 6.30pm.

• The practice had completed a clinical audit followingguidelines being published by NICE whichrecommended that every patient with a specific skincondition should have a cardiovascular risk assessment.The outcomes of the audit were shared within thepractice, locally with the CCG and nationally in apublished paper in the British Journal of GeneralPractice in September 2015.

• The practice had pioneered GP and advanced nursepractitioner (ANP) appointments at Pontefract GeneralInfirmary (A common venue where patients go to the

accident and emergency department) Saturday andSundays 11am – 4pm. They had written the businesscase, managed the pilot and assumed informationgovernance responsibility. GPs and ANPs from thepractice had helped to fulfil the rota for these clinics.This scheme had been launched in February 2015 andhad been extended until end of September 2015. TheGPs told us this had reduced attendance at accidentand emergency.

• The practice had identified a gap in the sexual healthservice in the area. One of the ANPs was recruited to tryand improve access to advice and support particularlyfor young people. The nurse had worked with theTerence Higgins Trust three years ago to bring in aweekly youth clinic for patients under the age of 18years. The clinic offered screening for sexuallytransmitted infections such as chlamydia andgonorrhoea. They also offered rapid access HIV thumbprick tests and if positive, bloods were then taken on thespot.

• The practice had supported a member of staff tocomplete training to enable them to implement the usesocial media as a tool to engage with patients. They hadset up a Facebook page and Twitter account. They usedthese systems to give generic health information and topromote health awareness.

• The practice had supported a health promotion day at alocal supermarket to identify patients in the area whomay have an undiagnosed condition no matter withwhich surgery they were registered. This had beenarranged based on evidence of higher prevalence ofhypertension and stroke in patients locally.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Outstanding –


Documents

Ferrybridge Medical Centre NewApproachComprehensive Report … · 2019. 11. 23. · Thisreportdescribesourjudgementofthequalityofcareatthisservice.Itisbasedonacombinationofwhatwefound